{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T10:17:13Z","timestamp":1778667433355,"version":"3.51.4"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"\n Background<\/jats:title>\n Cancer-related ischemic stroke is commonly suspected when diffusion-weighted imaging (DWI) shows multi-territory infarction with markedly elevated D-dimer. However, the prevalence and clinical relevance of non-coagulopathy phenotypes in patients with active cancer are not well defined.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively studied consecutive ischemic stroke admissions undergoing MRI-DWI at a single center. Active cancer was defined as diagnosis or treatment within 6 months, or metastatic\/recurrent disease. Infarct distribution (multi- vs. single-territory) was classified from official routine radiology reports by board-certified radiologists blinded to outcomes. We compared D-dimer across groups defined by cancer status and DWI distribution and examined predictors of multi-territory infarction within the active-cancer cohort using multivariable logistic regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among patients with active cancer (\n n<\/jats:italic>\n = 182), 25.3% (46\/182) had multi-territory infarction and 74.7% (136\/182) had single-territory infarction. D-dimer was higher in active-cancer patients with multi-territory infarction (median 6.8 \u03bcg\/mL; IQR 1.3\u201314.2) than in active-cancer patients with single-territory infarction (median 1.2 \u03bcg\/mL; IQR 0.5\u20133.3) and in non-cancer stroke groups (\n p<\/jats:italic>\n &lt; 0.001). Each doubling of D-dimer was independently associated with multi-territory infarction (adjusted OR 1.62; 95% CI 1.33\u20131.98).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Routine report-based phenotyping indicates that the classic coagulopathy phenotype is a strong marker but represents a minority of strokes with active cancer. When multi-territory infarction accompanies elevated D-dimer, evaluation should prioritize malignancy activity, systemic thrombosis\/coagulopathy, and non-bacterial thrombotic endocarditis; otherwise, a mechanism-oriented stroke work-up should be maintained, with attention to cancer treatment\u2013 and radiation-related vascular injury.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fneur.2026.1808174","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T09:43:54Z","timestamp":1778665434000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the coagulopathy phenotype in cancer-associated stroke: routine radiology report-based phenotyping and a practical diagnostic prioritization"],"prefix":"10.3389","volume":"17","author":[{"given":"Shinsuke","family":"Muraoka","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nagoya University Graduate School of Medicine","place":["Nagoya, Japan"]},{"name":"Department of Neurosurgery, Tosei General Hospital","place":["Seto, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaito","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Tosei General Hospital","place":["Seto, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Issei","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagoya University Graduate School of Medicine","place":["Nagoya, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunsaku","family":"Goto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagoya University Graduate School of Medicine","place":["Nagoya, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Nishihori","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagoya University Graduate School of Medicine","place":["Nagoya, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Izumi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagoya University Graduate School of Medicine","place":["Nagoya, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryuta","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagoya University Graduate School of Medicine","place":["Nagoya, Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1161\/STROKEAHA.109.571356","article-title":"Ischemic stroke in cancer patients with and without conventional mechanisms: a multicenter study in 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